Risk factors and outcome of extended-spectrum β-lactamase-producing Enterobacter cloacae bloodstream infections

Qureshi, Zubair A.; Paterson, David L.; Pakstis, Diana L.; Adams-Haduch, Jennifer; Sandkovsky, Gabriel; Sordillo, Emilia Mia; Polsky, Bruce; Peleg, Anton Y.; Bhussar, Manveen K.; Doi, Yohei

doi:10.1016/j.ijantimicag.2010.09.009

Cited by 65 publications

(59 citation statements)

References 29 publications

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“…Reports from the United Kingdom reported a high level of (40%) fecal carriage of ESBL-producing E. coli strains in nursing home residents (31). A recent multicenter study on ESBL-producing Enterobacter cloacae bloodstream infection in the United States also revealed that as many as 56.3% of patients with ESBL-producing E. cloacae were admitted from a nursing home and that ESBL production is one of the independent risk factors for ESBL production in their cohort (32). This study identified unique epidemiologic characteristics of patients harboring CTX-M E. coli compared to patients with non-CTX-M E. coli, including male gender, impaired consciousness, prior use of H2 blockers, immunosuppressive status, and exposure to penicillins and/or trimethoprim-sulfamethoxazole.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and Risk Factors for Isolation of Escherichia coli Producing CTX-M-Type Extended-Spectrum β-Lactamase in a Large U.S. Medical Center

Hayakawa

Gattu

Marchaim

et al. 2013

Antimicrob Agents Chemother

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Section: Discussionmentioning

confidence: 99%

Epidemiology and Risk Factors for Isolation of Escherichia coli Producing CTX-M-Type Extended-Spectrum β-Lactamase in a Large U.S. Medical Center

Hayakawa

Gattu

Marchaim

et al. 2013

Antimicrob Agents Chemother

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“…In a recent study (28), nine patients with ESBL-producing Enterobacter cloacae bloodstream infections were treated with cefepime, and it was found that four (66.7%) of six patients who were treated with cefepime and whose isolates had cefepime MICs of 0.25 to 3 g/ml showed clinical failure. Further well-designed prospective clinical studies are needed to determine the efficacy of ceftazidime, cefepime, and aztreonam in the treatment of in- …”

Section: Discussionmentioning

confidence: 99%

Susceptibility of Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae According to the New CLSI Breakpoints

Wang

Xiong

et al. 2011

J Clin Microbiol

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In 2010 the Clinical and Laboratory Standards Institute (CLSI) lowered the susceptibility breakpoints of some cephalosporins and aztreonam for Enterobacteriaceae and eliminated the need to perform screening for extended-spectrum ␤-lactamases (ESBLs) and confirmatory tests. The aim of this study was to determine how many ESBL-producing strains of three common species of Enterobacteriaceae test susceptible using the new breakpoints. As determined with the CLSI screening and confirmatory tests, 382 consecutive ESBL-producing strains were collected at Huashan Hospital between 2007 and 2008, including 158 strains of Escherichia coli, 164 of Klebsiella pneumoniae, and 60 of Proteus mirabilis. Susceptibility was determined by the CLSI agar dilution method. CTX-M-, TEM-, and SHV-specific genes were determined by PCR amplification and sequencing. bla CTX-M genes alone or in combination with bla SHV were present in 92.7% (354/382) of these ESBLproducing strains. Forty-two (25.6%) strains of K. pneumoniae harbored SHV-type ESBLs alone or in combination. No TEM ESBLs were found. Utilizing the new breakpoints, all 382 strains were resistant to cefazolin, cefotaxime, and ceftriaxone, while 85.0 to 96.7% of P. mirabilis strains tested susceptible to ceftazidime, cefepime, and aztreonam, 41.8 to 45.6% of E. coli strains appeared to be susceptible to ceftazidime and cefepime, and 20.1% of K. pneumoniae were susceptible to cefepime. In conclusion, all ESBL-producing strains of Enterobacteriaceae would be reported to be resistant to cefazolin, cefotaxime, and ceftriaxone by using the new CLSI breakpoints, but a substantial number of ESBL-containing P. mirabilis and E. coli strains would be reported to be susceptible to ceftazidime, cefepime, and aztreonam, which is likely due to the high prevalence of CTX-M type ESBLs.

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“…If we had used the clinical breakpoints furnished by the European Committee on Antimicrobial Susceptibility Testing (EUCAST; http://www.eucast.org), all of the strains would have be categorized as nonsusceptible to both cefepime and ceftazidime, and therapy with these drugs would have been classified as inadequate. Some investigators (49) have questioned the true efficacy of ceftazidime, cefepime, and aztreonam against ESBL-producing strains of Enterobacteriaceae strains that appear to be susceptible to these drugs on the basis of CLSI breakpoints, and others have reported poor outcomes when severe infections caused by ESBL producers are treated with oxyimino-cephalosporins, even when the MICs fall within the susceptible range (32,35). As Wang et al (49) have pointed out, larger multicenter studies (including tertiary as well as primary care centers and LTCFs) are needed to better define the efficacy of these antibiotics and optimal MIC cutoff points for their use in the treatment of severe infections caused by apparently susceptible ESBL-producing Enterobacteriaceae strains.…”

Section: Fig 2 Hospital Length Of Stay (Los) Following Bsi Onset In Smentioning

confidence: 99%

Multidrug-Resistant Proteus mirabilis Bloodstream Infections: Risk Factors and Outcomes

Tumbarello

Trecarichi

Fiori

et al. 2012

Antimicrob Agents Chemother

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Our aims were to identify (i) risk factors associated with the acquisition of multidrug-resistant (MDR, to 3 or more classes of antimicrobials) Proteus mirabilis isolates responsible for bloodstream infections (BSIs) and (ii) the impact on mortality of such infections. Risk factors for acquiring MDR P. mirabilis BSIs were investigated in a case-case-control study; those associated with mortality were assessed by comparing survivors and nonsurvivors in a cohort study. The population consisted of 99 adult inpatients with P. mirabilis BSIs identified by our laboratory over an 11-year period (1999 to 2009), 36 (33.3%) of which were caused by MDR strains, and the overall 21-day mortality rate was 30.3%. Acquisition of an MDR strain was independently associated with admission from a long-term care facility (odds ratio to which the isolate displayed in vitro resistance) more frequently than those with non-MDR infections; they also had increased mortality and (for survivors) longer post-BSI-onset hospital stays. In multivariate regression analysis, 21-day mortality was associated with septic shock at BSI onset (OR, 12.97; 95% CI, 32.2 to 52.23), P. mirabilis isolates that were MDR (OR, 6.62; 95% CI, 16.4 to 26.68), and IIAT (OR, 9.85; 95% CI, 26.7 to 36.25), the only modifiable risk factor of the 3. These findings can potentially improve clinicians' ability to identify P. mirabilis BSIs likely to be MDR, thereby reducing the risk of IIAT-a major risk factor for mortality in these cases-and facilitating the prompt implementation of appropriate infection control measures. The Gram-negative enteric bacterium Proteus mirabilis is an important cause of community-and health care-associated infections, including those involving the urinary tract, the abdominal cavity, and the bloodstream itself (13,19,50). Like many other members of the family Enterobacteriaceae, P. mirabilis can harbor numerous plasmid-and integron-mediated determinants of antimicrobial resistance (18). Multidrug-resistant (MDR) strains of P. mirabilis generally produce extended-spectrum ␤-lactamases (ESBLs) or the AmpC-type cephalosporinase and rarely carbapenemases, and their prevalence in some settings is relatively high (8,10,12,13,25,31,39,41).Over the past decade, the proportion of BSIs caused by Gramnegative bacteria has risen sharply (11,26,38,51). Although 1 to 3% of all BSIs are caused by P. mirabilis (11,26,38,51), the incidence of MDR in the strains responsible for these infections is a cause for concern. In general, MDR infections are known to have a significant impact on the prognosis and survival of hospitalized patients (9,14,24,42,43,46), but it is unclear whether MDR strains are associated with worse clinical outcomes in P. mirabilis BSIs. Endimiani et al. (13) found that treatment failure and death are likely to occur in ESBL-producing P. mirabilis BSIs. Unfortunately, this study was small, including 23 patients and only 9 patients with ESBL BSIs. However, we can reasonably assume that empirical therapy is even more likely to be inadequate...

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Risk factors and outcome of extended-spectrum β-lactamase-producing Enterobacter cloacae bloodstream infections

Cited by 65 publications

References 29 publications

Epidemiology and Risk Factors for Isolation of Escherichia coli Producing CTX-M-Type Extended-Spectrum β-Lactamase in a Large U.S. Medical Center

Epidemiology and Risk Factors for Isolation of Escherichia coli Producing CTX-M-Type Extended-Spectrum β-Lactamase in a Large U.S. Medical Center

Susceptibility of Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae According to the New CLSI Breakpoints

Multidrug-Resistant Proteus mirabilis Bloodstream Infections: Risk Factors and Outcomes

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